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Elife. 2018 Dec 18;7. pii: e39435. doi: 10.7554/eLife.39435.

The distribution of antibiotic use and its association with antibiotic resistance.

Author information

1
Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States.
2
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, United States.
3
Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States.
4
Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.
5
Boston Children's Hospital, Boston, United States.
6
Harvard Medical School, Boston, United States.
7
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States.
8
Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, United States.
9
Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States.

Abstract

Antibiotic use is a primary driver of antibiotic resistance. However, antibiotic use can be distributed in different ways in a population, and the association between the distribution of use and antibiotic resistance has not been explored. Here, we tested the hypothesis that repeated use of antibiotics has a stronger association with population-wide antibiotic resistance than broadly-distributed, low-intensity use. First, we characterized the distribution of outpatient antibiotic use across US states, finding that antibiotic use is uneven and that repeated use of antibiotics makes up a minority of antibiotic use. Second, we compared antibiotic use with resistance for 72 pathogen-antibiotic combinations across states. Finally, having partitioned total use into extensive and intensive margins, we found that intense use had a weaker association with resistance than extensive use. If the use-resistance relationship is causal, these results suggest that reducing total use and selection intensity will require reducing broadly distributed, low-intensity use.

KEYWORDS:

E. coli; S. pyogenes; antibiotic resistance; antimicrobial; epidemiology; global health; infectious disease; microbiology; public health

PMID:
30560781
PMCID:
PMC6307856
DOI:
10.7554/eLife.39435
[Indexed for MEDLINE]
Free PMC Article

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